糖尿病微血管并发症随病程增加而非年龄

墨尔本——国际多中心ADVANCE试验数据二次分析结果显示，50岁之前确诊为2型糖尿病与微血管并发症风险增加相关。

该试验主要研究者John Chalmers博士在世界糖尿病大会(WDC)上报告称，研究结果显示，眼部和肾脏微血管并发症风险随病程增加而增加，不过与患者年龄无关，但心梗、卒中和心血管事件以及全因死亡率等大血管并发症风险与患者年龄和病程均相关。
 
悉尼乔治研究所资深所长、悉尼大学荣誉医学教授Chalmers博士指出，上述结果表明，早期罹患2型糖尿病患者处境可能更为艰难，疾病可能出现更多进展、更具侵袭性和药物抵抗。意识到这一点非常重要，应控制血糖并持续关注肾脏和眼部病变。

ADVANCE是一项在20个国家开展的随机试验，对11,140例2型糖尿病成人患者进行了为期5年的降压和强化与标准血糖控制治疗的对照随访研究。患者入组平均年龄66岁，糖尿病平均病程7.9年。当研究者对患者以5年病程作为增量进行分层后发现，每一组患者平均年龄基本相同，约为66岁。

“你可能推测病程最长的患者年龄也会最大，但实际并非如此。” Chalmers博士说道。

结果显示，7.5%的病程<5年的患者有主要微血管病变史，病程>15年患者的这一比例为18.6%。病程最长(>15年)患者平均确诊年龄为47岁，而病程<5年的患者为63岁。

研究还发现，病程最长患者基线平均HA1c最高，为7.9%，而病程<5年的患者为7.2%。

Chalmers博士指出，主要大血管事件随患者年龄和病程增加急剧提高，两者均为独立影响因素。微血管并发症受血糖负担影响较大，而大血管事件则更多地与血压、胆固醇和吸烟等传统风险因素有关。

该研究的部分资金来源于Preterax(培哚普利精氨酸盐+吲达帕胺)制造商施维雅。Chalmers博士披露他作为该项研究的主要研究者接受了施维雅的研究经费和酬金。

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By: BIANCA NOGRADY, Cardiology News Digital Network

MELBOURNE – A diagnosis of type 2 diabetes before age 50 was associated with an increased risk of microvascular complications, based on a secondary analysis of data from the international ADVANCE trial.

In ADVANCE, the risk of microvascular complications, such as eye and kidney disease, increased with disease duration but not with patient age. The risk of macrovascular complications, such as myocardial infarction, stroke, and cardiovascular events, as well as all-cause mortality, increased with both patient age and disease duration, Dr. John Chalmers, principal investigator for ADVANCE, said at the World Diabetes Congress.
 
"The findings tell you that if you get [type 2 diabetes] early, you’re in for a rougher time. If you’re younger at the time of diagnosis, then you may have a slightly more progressive, aggressive, resistant-to-treatment form of type 2 diabetes. It’s important to be aware of that, to control the glucose and to keep looking at the kidneys and eyes," said Dr. Chalmers, senior director of the George Institute, Sydney, and emeritus professor of medicine at the University of Sydney.

ADVANCE is a randomized trial across 20 countries of blood pressure lowering and intensive versus standard glucose control in 11,140 adults with type 2 diabetes who were followed up for 5 years. Mean age at study entry was 66 years, and average diabetes duration was 7.9 years. However when patients were stratified in 5-year increments of disease duration, researchers observed that the average age for each increment was roughly the same, around 66 years.

"You might guess a priori that people with the longest duration might be the oldest, but they’re not necessarily," Dr. Chalmers said in an interview.

In ADVANCE, 7.5% of patients with disease duration of less than 5 years had a history of major microvascular disease, as did 18.6% of those with disease duration of more than 15 years. The patients with the longest duration of disease – more than 15 years – started at a mean age of 47, and those with less than 5 years’ disease duration started at a mean age of 63.

The study also noted that those with the longest duration of disease had the highest mean hemoglobin A1c at baseline, 7.9%, compared with 7.2% in patients with less than 5 years’ disease duration.

"Major macrovascular events rise steeply as patients get older and as the duration of diabetes increases; they both have independent effects," he said. "The microvascular complications are more influenced by the glycemic burden, whereas the macrovascular events are probably more affected by the traditional risk factors of blood pressure, cholesterol, and smoking."

The ADVANCE study was partly funded by Servier, the maker of Preterax (perindopril arginine plus indapamide). Dr. Chalmers declared that he received research grants and honoraria from Servier as the principal investigator for the study.